Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018

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"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."

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On Sep 2018

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"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

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"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
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On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : November | Volume : 16 | Issue : 11 | Page : EC12 - EC15 Full Version

Complete Blood Count (CBC) and CBC derived Ratios in Early Diagnosis of COVID-19: A Retrospective Single-centre Study

Published: November 1, 2022 | DOI:
Balamurugan Senthilnayagam, Afrin Fathima, Karthika Rajenderan, S Preethi, Khowsalya Subrajaa, S Manjani

1. Professor and Head, Department of Pathology, Bhaarath Medical College and Hospital (BIHER), Chennai, Tamil Nadu, India. 2. Assistant Professor, Department of Pathology, Bhaarath Medical College and Hospital (BIHER), Chennai, Tamil Nadu, India. 3. Assistant Professor, Department of Pathology, Bhaarath Medical College and Hospital (BIHER), Chennai, Tamil Nadu, India. 4. Associate Professor, Department of Pathology, Bhaarath Medical College and Hospital (BIHER), Chennai, Tamil Nadu, India. 5. Assistant Professor, Department of Pathology, Bhaarath Medical College and Hospital (BIHER), Chennai, Tamil Nadu, India. 6. Associate Professor, Department of Pathology, Bhaarath Medical College and Hospital (BIHER), Chennai, Tamil Nadu, India.

Correspondence Address :
Dr. Balamurugan Senthilnayagam,
Professor and Head, Department of Pathology, Bhaarath Medical College and Hospital (BIHER), Chennai, Tamil Nadu, India.


Introduction: Abnormalities in Complete Blood Count (CBC) are frequently observed in Coronavirus Disease-2019 (COVID-19) infection. So, CBC can serve as a simple tool for the early diagnosis of COVID-19.

Aim: To evaluate the diagnostic ability of CBC test in COVID-19 infection.

Materials and Methods: In this retrospective observational single-centred, data were collected from 102 adult non critical care patients who presented with acute fever between May 2020 and December 2020. Among 102 patients’ data, 48 were found Reverse Transcriptase-Polymerase Chain Reaction (RTPCR) positive (‘cases’) and 54 were RT-PCR negative (‘controls’). Non parametric Mann-Whitney test was used to compare the differences in CBC. The p-value <0.05 was considered statistically significant. Receiver Operator Characteristic (ROC) analysis was used to evaluate the diagnostic accuracy of CBC tests in COVID19. For this, RT-PCR was used as the ‘gold standard’ and CBC as the index test. Area Under Curve (AUC) was determined for each of the CBC tests. All statistical analysis were done using Medcalc software.

Results: The mean age of cases was 48±14 years (62% males; 38% females) and controls was 45±15 years (55% males; 45% females). Median values for haemoglobin, haematocrit, Red Blood Cell (RBC) count and Red cell Distribution Width (RDW) were significantly higher (p-value <0.05) and total White Blood Cell (WBC) count, eosinophil differential count, absolute eosinophil count, lymphocyte count, absolute lymphocyte count, immature granulocyte count were significantly lower in COVID-19 patients as compared to controls. Significant differences were observed for eosinophil (differential% and absolute) count. Almost all the platelet parameters were lower in COVID-19 patients (except Neutrophil Lymphocyte Ratio {NLR}), although the platelet count was only mildly reduced in the RT-PCR positive cases (133-475×103/μL;median-227.98×103/μL). Higher AUC values were observed with Eosinophil-differential%, Eosinophil-absolute count, Eosinophil Lymphocyte Ratio (ELR) and NLR.

Conclusion: Eosinophil count and associated ratio (Eosinophil Lymphocyte Ratio) are diagnostically useful and can serve as biomarkers for COVID-19. Further larger studies are needed to unravel the underlying mechanism and their clinical utility.


Biomarkers, Coronavirus disease-2019, Eary recognition, Reverse transcriptase polymerase chain reaction

Although COVID-19 was primarily documented as respiratory infection, now it is considered a systemic infection which can involve multiple systems in the body like cardiovascular, gastrointestinal, haematopoietic etc (1),(2). Various haematological changes are reported in COVID-19 patients lymphocytopenia, eosinopenia, neutrophilia and increased NLR are reported in the literature (3). But, comprehensive data covering all CBC tests are limited. Also, recently there is an interest in utilising CBC tests in early recognition and diagnosis of COVID-19 (4).

The gold standard diagnostic test for COVID-19, RT-PCR, is fraught with limitations like technical complexity, availability of resources and turn-around-time. In order to accelerate the disease recognition especially in under-resourced settings, simpler biomarkers need to be explored. CBC or haemogram is a simple, easily available and routinely ordered haematology test. The present study aimed at comparing the CBC test values between RT-PCR positive and RT-PCR negative patient groups and also to examine the diagnostic value of these tests for COVID-19 diagnosis as compared to RT-PCR gold standard.

Material and Methods

This was a retrospective observational single-centred conducted during 2021-22 on data of patients who presented to a governmentdesignated COVID-19 facility, during the period May 2020 to December 2020. Demographic, clinical details, and laboratory details were collected from the hospital medical records department.

Informed Consent and Institutional Ethics Committee (IEC) clearance (BEC-012/21) were obtained before the study was carried out.

Inclusion criteria: Adults (>18 years) presenting with acute fever and who had test results of both RT-PCR and CBC done at the time of presentation were included in the study.

Exclusion criteria: Patients requiring critical care, PaO2<90 and with missing clinical and laboratory data or relevant information were excluded from the study.

Sample size calculation: Sample size was calculated using the formula by Buderer N (5). A total of 102 eligible subjects were included in the study (random sampling). A total of 48/102 were RTPCR positive (‘cases’) and 54/102 were RT-PCR negative (‘controls’).

Study Procedure

For the present study, RT-PCR was considered as the ‘gold standard test’ for COVID-19 diagnosis and Complete Blood Count as the ‘index test’. Following parameters were reported as part of CBC: Haemoglobin (Hb), Haematocrit (Hct), RBC count, Mean Corpuscular Volume (MCV), Mean Corpuscular Haemoglobin (MCH), Mean Corpuscular Haemoglobin Concentration (MCHC), Red Blood Cell Distribution Width-Standard Deviation (RDW-SD), Total WBC count, Differential WBC counts, Absolute WBC counts, Immature granulocyte% and count, Atypical Lymphocyte% and count, Platelet count, Mean Platelet Volume (MPV), Platelet Distribution Width (PDW), Plateletcrit (PcT). CBC-derived ratios such as Neutrophil Lymphocyte Ratio, Lymphocyte Monocyte Ratio, Eosinophil-lymphocyte Ratio, Platelet Large Cell Count (P-LCC) and Platelet Large Cell Ratio (P-LCR) were calculated from CBC results using Microsoft Excel.

Statistical Analysis

The Kolmogorov-Smirnov test was used to evaluate the variable distributions for normality. As the distribution of CBC was non normal, following statistical characteristics of CBC-lower and highest value, median and interquartile range were computed in both case and control groups. Non parametric Mann-Whitney U test was used to determine the statistical significance for differences in median CBC values between the two groups. The p-value <0.05 was considered significant. To evaluate the diagnostic accuracy of different CBC tests in COVID-19 diagnosis, ROC analysis was utilised. AUC values and sensitivity and specificity at optimum cut-offs for different CBC were determined. All the statistical analyses were performed using the statistical software Medcalc, -version 19.5.6.


The mean age of cases was 48±14 years (62% males; 38% females) and controls was 45±15 years (55% males; 45% females). Median values for haemoglobin, haematocrit, RBC count, and RDW were significantly higher (p-value <0.05) in RT-PCR positive cases as compared to the RT-PCR negative controls. However, no significant difference was observed for other RBC indices (MCV, MCH and MCHC) (Table/Fig 1). With regard to WBC parameters, median values for total WBC count, eosinophil differential count, absolute eosinophil count, lymphocyte count, absolute lymphocyte count, immature granulocyte count were significantly lower in COVID-19 patients as compared to controls. On the other hand, neutrophil differential count and atypical lymphocyte count were higher in RTPCR positive cases (Table/Fig 2). Almost all the platelet parameters were lower in COVID-19 patients; although the platelet count was only mildly reduced in the RT-PCR positive cases (133-475×103/μL;median-227.98×103/μL) (Table/Fig 3). Area Under Curve values >0.7 were observed for Eosinophil% (0.72), Absolute Eosinophil Count (0.72), Eosinophil Lymphocyte Ratio (0.71) and RBC Count (0.71).


Early diagnosis of COVID-19 is essential on account of its high infectivity and mortality. Though RT-PCR is the gold standard for diagnosis, it is limited by technical complexity and delays in turn-around time. The current study examined the CBC and its derived ratios for early recognition of COVID-19 as they are simple, inexpensive, easily available and routinely ordered test.

Significantly higher values for haemoglobin, haematocrit, RBC count and RDW were observed in RT-PCR positive cases. The present study was similar to study by Guan WJ et al., Liu X et al., Xu XW et al., and Usul E et al., (6),(7),(8),(9). However, Yuan X et al., and Mei X et al., reported lower values in critically ill and severe COVID-19 patients (10),(11). This difference is attributable to the severity of the disease and other associated co-morbid conditions. The study cohort included onlymild COVID-19. There was no difference in MCV, MCH and MCHC between the two groups. As many authors didn’t report on these indices, authors could not compare present study findings with others (12),(13),(14),(15).

There was a significantly lower total WBC count, lymphocyte count (differential and absolute) and eosinophil count (differential and absolute) in RT-PCR positive patients. There was a significant increase in neutrophil differential count in RT-PCR positive group, but there was no difference in the absolute neutrophil count between the groups. This was in agreement with few other studies (16),(17),(18). There was an increased atypical lymphocyte count (both differential and absolute) and decreased immature granulocyte count (both differential and absolute) in the case group. Though few studies have described abnormalities in WBC morphology in peripheral smear, there were no published studies on these analyser-derived parameters to compare with (16),(17). Among the CBC parameters, changes in eosinophil count were the most significant. In fact, the eosinophil differential% and absolute eosinophil count had the highest AUC values among all the CBCs, indicating that they are the most important discriminatory tool in the early recognition of COVID-19. This was similar to a study by Soni M, where eosinopenia was found to be a diagnostic and prognostic marker with as much as 78% of patients having low or zero eosinophil count (16). Platelet count was significantly lower in RT-PCR positive patients; so, also the other platelet indices-MPV, PDW and PcT. Similar findings were observed by Ozcelik N et al., Rahman A et al., observed that though thrombocytopenia was found in 5-21% of COVID-19 patients, the severity was less compared to other viral infections like Dengue (19),(20). With respect to CBC-derived ratios, NLR and ELR had the highest AUC for COVID-19 diagnosis. This was comparable to a study by Yang H et al., on CBC parameters (lymphocyte count, neutrophil count, monocyte count, NLR and LMR) who observed highest AUC for NLR and also found it to be prognostically useful. However the study did not include eosinophil or its derived ratios (21).

The AUC values were the highest for absolute eosinophil count, eosinophil%, eosinophil lymphocyte ratio and RBC count making them potential markers in recognising COVID-19. The commonly tested NLR had an AUC of 0.62 in the present study, but had the highest specificity among the CBC tests and CBC-derived ratios.


The present study was a retrospective study and did not attempt to explore the dynamic changes of the test values or their prognostic utility.


Significant haematological changes occur in COVID-19 patients. Lymphocytopenia, neutrophilia and eosinopenia are observed in COVID-19 individuals. Eosinophil Count (differential% and absolute count) and CBC-derived ratio ELR are the most promising markers useful in the early recognition of COVD-19 in addition to NLR.


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DOI and Others

DOI: 10.7860/JCDR/2022/59495.17083

Date of Submission: Aug 05, 2022
Date of Peer Review: Aug 24, 2022
Date of Acceptance: Oct 15, 2022
Date of Publishing: Nov 01, 2022

Author declaration:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

• Plagiarism X-checker: Aug 06, 2022
• Manual Googling: Oct 10, 2022
• iThenticate Software: Oct 14, 2022 (6%)

Etymology: Author Origin

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